About one in every five patients who is hospitalized ends up back in hospital within a month, researchers reported in JAMA. Forty percent of those do so via the emergency department.
According to the background information in the article, the readmissions are often related to the first hospitalization and can be extremely costly.
The authors added:
The purpose of the study was to identify the extent of acute care service among patients 30 days after being discharged, in particular the number of ED visits and readmissions that occurred. The researchers monitored patients between July 2008 and September 2009 in California, Nebraska and Florida using information from the Healthcare Cost and Utilization Project state inpatient and ED databases.
They analyzed 5,032,254 index hospitalizations in 4,028,555 patients. 48 percent of the patients were Caucasian and a little over half were women (53.5 percent). 17.9% of the hospitalization cases were found to result in the need for acute care within 30 days of discharge, with 7.5% of discharges resulting in an ED encounter and 12.3 percent resulting in a readmission. ED visits made up close to 40% of the acute care encounters.
There were over 470 different index discharge conditions found, ranging from breast malignancy to benign prostatic hypertrophy.
The authors said:
“In conclusion, hospital-based acute care encounters are frequent among patients recently discharged from an inpatient setting. An improved understanding of how the ED setting is best used in the management of acute care needs – particularly for patients recently discharged from the hospital – is an important component of the effort to improve care transitions. The use of hospital readmissions as a lone metric for postdischarge health care quality may be incomplete without considering the role of the ED.”
“Just as the Patient Protection and Affordable Care Act requires the development of programs to reduce readmissions, further initiatives are necessary to understand the drivers of postdischarge ED use and the clinical and financial efficiency associated with providing such acute care in the ED.”
As hospitals fear new Medicare penalties, they are trying to reduce the total number of patients who end up back in hospital. The authors say this problem is not an easy one to resolve.
The authors suggest that poor coordination among different health care providers after patients are discharged leaves the hospital mainly to blame for a large number of readmissions. America’s healthcare system needs to focus more carefully on improving post-hospital discharge care.
Hospitals might not be properly identifying patients who are at high risk of complications or new illnesses after they leave hospital. Experts say that there is not enough support for patients to make the transition from hospital to home.
Researchers reported in the Journal of the American College of Surgeons (August 2012 issue) that complications after surgery are general the main reason patients are readmitted to hospital within thirty days.
Senior author, John F. Sweeney, MD, FACS, said that hospital readmissions are the tip of the iceberg. He added “When you dig deeper, it is the postoperative complications that drive readmissions among general surgical patients. Better understanding that predictors of readmission for general surgery patients will allow hospitals to develop programs to decrease readmission rates.”
Written by Joseph Nordqvist